Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

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contrast, only 35% of the applicants received the superlative response regarding their "differential diagnosis ability." The "global assessment" operated similarly, with 37% of the applicants receiving the superlative response. The least common superlative response was the "match rating," with only 23% of the applicants receiving a "guaranteed match." These data can serve as a reference for both interpreting and writing SLORs. The data show that EM applicants least commonly receive the superlative response in the categories of "differential diagnosis ability," "global assessment," and "match rating," making these key categories for residency selection committees. These results suggest that authors can justifiably evaluate most applicants in the highest categories of personal traits, but that they should be more discerning with assessing "differential diagnosis ability," "global assessment," and "match rating."[88] Harwood et al seem <strong>to</strong> pretend as if ratings were objective facts, rather than what they are, subjective appraisals based on the author's claimed but unverifiable (and probably negligible) familiarity with the trainee. In the foregoing passage, Harwood et al urged institutional authors of SLORs (standardized letters of reference) <strong>to</strong> manipulate their performance-appraisals in various sections of the SLOR, on the premise that the evidentiary basis of such appraisals don't matter, with a view <strong>to</strong> pandering <strong>to</strong> the selection-committees for emergency-medicine residencies and manipulating the outcomes of their deliberations over trainee-selection. Harwood et al seem <strong>to</strong> ignore the possibility that fewer authors rate trainees highly in the glittering-generality categories of "differential diagnosis ability," "global assessment," and "match rating" than in the glittering-generality categories, "commitment," "work ethic," and "personality" because the authors could be inappropriately ungenerous with their ratings in the first three categories, most likely because those categories are the clinically oriented ones and authors would very likely believe that they weren't performing their watchdog/gatekeeper function properly (<strong>to</strong> keep bad doc<strong>to</strong>rs from practicing emergency-medicine) unless they had condemned a certain quota of trainee-candidates with each batch that left their respective institutions. Hea<strong>to</strong>n depicts that practice in terms of what he calls the “basic process”: The Basic Process The basic process of an individual in a hierarchy is <strong>to</strong> avoid mistakes. . . individuals are rated by their errors, for their tasks are predetermined. There is no premium for achievement outside assigned hierarchical tasks but there are penalties for every shortfall from perfection. The normal distribution in a hierarchy includes a percentage of failures, so grading on a curve means that students making the most mistakes are given failing grades. . . When failing students are eliminated, those next above them succeed <strong>to</strong> the failing category. The rule of thumb is for one-third <strong>to</strong> leave between the fifth and twelfth grades, . . . The next third become failure-threatened, declining in rank regardless of effort or improvement. Apprehension then blocks learning so there can only be unskilled repetition. Thus this middle third is taught submission and place within the hierarchy. . . (32)
Is it true or false that for every winner there has <strong>to</strong> be a loser? False – there has <strong>to</strong> be a continuing supply of losers if a winner is <strong>to</strong> keep on winning. In schools, grading on a curve . . . means that the A student needs an F student at the other end of the normal distribution; then annually or more often, when the F student is eliminated or drops out, another student must be pushed in<strong>to</strong> the failing position. . . companies seem <strong>to</strong> survive only by establishing a large pool of marginal workers who can be picked up when needed and dropped when business is slow. . . . . . Schools in exclusive suburbs do not produce so many failures . . . Instead they assume their students are mostly in the upper half of a normal (59) distribution. . . there are schools which assume their students are mostly in the lower half of a normal distribution. In one vocational high school in New York, no teacher could give a grade above C without special approval by the principal. In a ghet<strong>to</strong> high school a department head <strong>to</strong>ld me that only one student in a . . . class of twenty was capable of learning. I knew the students were capable and interested, but sure enough, nineteen dropped out and failed. . . grading in schools is a process that produces failures and accomplishes rejecting. Winners are cus<strong>to</strong>m-made, but losers are mass-produced. . . (62)[52] Pursuing a similar line of “reasoning,” raters in medical education may believe that they can enhance the reputation and credibility of their respective institutions by making a big show of being “<strong>to</strong>ugh graders” and the clinically oriented rating criteria are the most attractive targets for that sort of behavior. i. dis<strong>to</strong>rtion from “confidentiality,” under perpetual tension. In both edi<strong>to</strong>rial peer-review and performance-appraisal/LOR, the thesis is that the rater cannot deliver an “honest and accurate”[89] rating unless he labors under the protection of “confidentiality,”[61,89,90] meaning that everybody except for the subject, gets <strong>to</strong> see the rating. Decades of organizational oppression, in which ratees had <strong>to</strong> <strong>to</strong>lerate the in<strong>to</strong>lerable, finally prompted the US Congress <strong>to</strong> enact the enlightened Buckley Amendment, a federal law that requires schools that receive federal funding <strong>to</strong> make student records available for viewing by parents and the students themselves if they are 18 or older.[89,91] Accordingly, even though federal law mandates that the trainee should be able <strong>to</strong> see his rating, those in medical education, prefer the old oppression. They recommend that the organization should compel the trainee <strong>to</strong> “waive” his legal right, under the Buckley-Amendment, <strong>to</strong> see his rating, in the interest of “honesty”,[1,90] “authenticity,”[89] and “objectivity” (read freedom of the rater <strong>to</strong> give an adverse rating with the security of knowing that the ratee cannot learn of it and therefore not have grounds for retaliation) of the letter and of its “value”[1] <strong>to</strong> the receiving institution. In edi<strong>to</strong>rial peer-review, the author receives the rating but not the identity of the rater. In performance-appraisal, the trainee knows the identity of the rater but, ideally, not the rating. Yet, dissenting voices resist such organizational oppression, and for good reason, in my view:
Page 1 and 2: DR. ERIC N GROSCH - A new approach
Page 3 and 4: i. distortion from
Page 5 and 6: they were inferior. It is unfair, a
Page 7 and 8: Another Irving Langmuir? Can Americ
Page 9 and 10: deviations, as is the case when the
Page 11 and 12: method[11,12] for “objective” e
Page 13 and 14: than we now possess.[21] The progre
Page 15 and 16: 3. Descriptive, Not Evaluative. Use
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Page 19 and 20: etter than any of his contemporarie
Page 21 and 22: In the industrial setting, in which
Page 23: criteria did the evaluato</
Page 27 and 28: and the results . . . have been goo
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Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

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